Diffuse idiopathic skeletal hyperostosis (DISH) in pre-Columbian North America: Evidence from the eastern Tennessee River Valley

• Two pre-Columbian cases and one possible case of DISH are identified.
• The osteoarchaeological samples are from East Tennessee and are Late Prehistoric.
• The cases are the first paleopathological prevalence data for DISH in North America.
• DISH is often clinically associated with a high calorie affluent lifestyle.
• The low prevalence (<1%) suggests an absence of caloric abundance conducive to DISH.

Diffuse idiopathic skeletal hyperostosis (DISH or Forestier's disease) is a pathological condition of unknown etiology characterized by the exuberant antero-lateral flowing (‘dripping candle wax’) ossification of the anterior spinal ligaments. Clinical data indicate it is a progressive male-predilected pathology manifested in middle age, which steeply rises in prevalence after aged 60. It has become paleopathologically relevant because it has been clinically associated with an affluent lifestyle. Archeological examination of the prevalence of DISH is often undertaken on European samples and frequently in monastic contexts. There are no prevalence data for pre-Columbian samples from North America. The present study establishes baseline information from four prehistoric Late Mississippian period (AD 1300–1600) samples (N = 389) from the upper Tennessee River Valley. Two probable cases and one possible case of DISH (all male) are identified, reflecting less than one percent of the adult sample, and 1.2 percent (2/172) of males. The low prevalence compared to European monastic samples and non-New World cemetery contexts suggests socioeconomic or interpopulational genetic differences that may be tested with subsistence and community health-status controlled osteoarchaeological comparisons within and outside of North America.